Healthcare Claims Operations Supervisor

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🕒 vor 7 Tagen

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

⚙️ Operations

Jetzt Bewerben

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Imagenet LLC

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

⚕️ Krankenversicherung

🛍️ eCommerce

☁️ SaaS

💰 Private Equity Round im 2022-12

Healthcare Insurance • eCommerce • SaaS

Imagenet LLC ist ein führender Anbieter von Business-Continuity-Services für Gesundheitsorganisationen und spezialisiert auf digitale Postraumlösungen, Schadenregulierung, Kontaktcenter-Betrieb und Workflow-Management. Mit über zwei Jahrzehnten Erfahrung und dem Ruf, Effizienz und Genauigkeit zu verbessern, arbeitet Imagenet mit Gesundheitsplänen zusammen, um Prozesse zu optimieren und die Mitgliedszufriedenheit zu erhöhen. Ihre Dienstleistungen sind darauf ausgelegt, die Abwicklungszeiten von Ansprüchen zu verkürzen, die Verarbeitungskapazitäten zu erhöhen und die Wartezeiten im Kontaktcenter zu verkürzen. Durch die Integration skalierbarer Lösungen, die auf spezifische Bedürfnisse zugeschnitten sind, ermöglicht Imagenet Gesundheitsorganisationen, die Produktivität zu steigern und operative Herausforderungen zu bewältigen.

Beschreibung

• Oversee daily claims operations across assigned accounts and lines of business • Ensure achievement of all client KPIs, SLAs, quality standards, and operational deliverables • Monitor productivity, inventory, aging, turnaround times, workflow distribution, attendance, and backlog risks • Develop and execute action plans to address performance gaps and operational challenges • Partner with Workforce Management and Operations Leadership on staffing, forecasting, and capacity planning • Support implementations, transitions, and account expansions to ensure operational readiness • Successfully complete training and demonstrate proficiency in assigned claims processes • Maintain ownership of account-level operational metrics and performance outcomes • Analyze trends related to productivity, quality, error rates, SLA compliance, attendance, inventory aging, and client escalations • Hold Team Leads and staff accountable through coaching, performance reviews, corrective actions, and performance improvement plans • Drive a culture of urgency, accountability, and continuous improvement • Ensure timely resolution of performance issues and consistent execution of operational expectations • Serve as a primary operational contact for assigned client accounts • Participate in weekly, monthly, and quarterly business reviews, client meetings, calibrations, and operational discussions • Build strong client relationships through proactive communication and consistent operational performance • Manage client concerns and escalations with clear ownership, timely follow-through, and effective resolution • Collaborate with Account Management and Leadership to support client satisfaction, retention, and growth • Prepare, analyze, and present operational reports, dashboards, and performance metrics • Deliver accurate and timely reporting to clients and internal leadership • Identify trends, risks, and opportunities through data analysis and recommend actionable solutions • Utilize Excel, Power BI, client systems, and operational reporting tools to monitor account performance • Present performance results, improvement initiatives, and operational recommendations professionally and effectively • Ensure compliance with client requirements, HIPAA regulations, CMS guidelines, and company policies • Partner with Quality Assurance teams on calibrations, audits, error trend analysis, and remediation efforts • Conduct root cause analysis and implement corrective actions to improve quality and efficiency • Support audit readiness, compliance initiatives, and process improvement programs • Coach, mentor, and develop Team Leads and Claims Examiners • Support onboarding, nesting, cross-training, and ongoing employee development • Reinforce leadership accountability and operational excellence • Promote employee engagement, retention, succession planning, and professional growth • Foster a culture of teamwork, ownership, professionalism, and high performance

🎯 Anforderungen

• Minimum 3–5 years of healthcare claims leadership experience • Prior supervisory experience overseeing production teams required • Strong experience managing healthcare payer operations and claims workflows • Experience with client-facing operations and client relationship management • Strong reporting and data analysis experience required • Experience owning operational KPIs and performance deliverables • Strong leadership, accountability, organizational, and communication skills • Experience with systems such as EZ-CAP, QNXT, Facets, Jiva, Plexis, or similar preferred • Intermediate to advanced Excel and reporting/dashboard experience required • Experience managing offshore and/or remote teams preferred

🏖️ Vorteile

• Remote work offered • Equipment provided • Paid training to set you up for success • Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) • Paid Time Off (PTO) • 7 paid holidays • A supportive team and a company that values internal growth